From 1970 to 1973, 147 patients were treated at Wayne State University Affiliated Hospitals for perforated duodenal ulcer disease. One hundred thirteen were observed for at least 18 months and findings showed that (1) mortality was dependent on the condition of the patient rather than on the choice of operation, (2) current indications (previous ulcer history, degree of peritoneal contamination, and time interval between perforation and surgery) were not reliable in choosing the initial operation or in predicting the need for subsequent surgery, and (3) morbidity was high following simple closure. Therefore, we recommend vagotomy and pyloroplasty as the procedure of choice for a perforated duodenal ulcer, unless the patient is in septic shock at admission.
Kirkpatrick JR. The Role of Definitive Surgery in the Management of Perforated Duodenal Ulcer Disease. Arch Surg. 1975;110(8):1016-1020. doi:10.1001/archsurg.1975.01360140160031